1. Date of download: 5/31/2016 Copyright © 2016 American Medical Association. All rights reserved. From: Assessment of the Protective Effect of Pneumococcal Vaccination in Preventing Meningitis After Cochlear Implantation Arch Otolaryngol Head Neck Surg. 2007;133(10):987-994. doi:10.1001/archotol.133.10.987 Cumulative incidence of meningitis over 120 hours (5 days) in unimmunized and immunized rats that underwent implantation with cochlear implants. Abbreviations indicate routes of bacterial inoculation: IE, inner ear; IP, intraperitoneal; and ME, middle ear. The 6 immunized, IP-inoculated rats are not presented on the graph because their cumulative incidence rate was 0%. Figure Legend:

2. Date of download: 5/31/2016 Copyright © 2016 American Medical Association. All rights reserved. From: Assessment of the Protective Effect of Pneumococcal Vaccination in Preventing Meningitis After Cochlear Implantation Arch Otolaryngol Head Neck Surg. 2007;133(10):987-994. doi:10.1001/archotol.133.10.987 Low-power photomicrographs showing a cochlea with a scala tympani electrode array implant (im) (A) and the contralateral control cochlea (B) of an immunized rat 120 hours following intraperitoneal inoculation of 4 × 10 6 colony forming units of Streptococcus pneumoniae. This animal did not exhibit clinical or histologic central nervous system evidence of meningitis. The scalae of both cochleae were devoid of gross infection. For both panels, the scale bar indicates 200 μm (hematoxylin-eosin). Figure Legend:

3. Date of download: 5/31/2016 Copyright © 2016 American Medical Association. All rights reserved. From: Assessment of the Protective Effect of Pneumococcal Vaccination in Preventing Meningitis After Cochlear Implantation Arch Otolaryngol Head Neck Surg. 2007;133(10):987-994. doi:10.1001/archotol.133.10.987 Photomicrographs of rat cochlea specimens. A and B, Low-power photomicrographs (scale bar indicates 200 μm) illustrating the cochlea with the scala tympani electrode array implant (im) (A) and the contralateral control cochlea (B) of an immunized rat 120 hours following middle-ear inoculation of 3 × 10 4 colony forming units of Streptococcus pneumoniae (hematoxylin-eosin). This animal exhibited clinical and histologic central nervous system evidence of meningitis. In this example, there is a severe labyrinthitis apparent throughout the ear with the implant (A), while the contralateral cochlea (B) exhibits evidence of infection mainly localized to the modiolus (c) and internal acoustic meatus (d). The c and d areas in panel B are shown enlarged in panels C and D, respectively. C and D, Higher-power photomicrographs (scale bar indicates 10 μm) of gram-stained sections of the modiolus (C) and internal acoustic meatus (D) of the contralateral cochlea illustrate the presence of bacteria (arrows); bn indicates bone. Figure Legend:

4. Date of download: 5/31/2016 Copyright © 2016 American Medical Association. All rights reserved. From: Assessment of the Protective Effect of Pneumococcal Vaccination in Preventing Meningitis After Cochlear Implantation Arch Otolaryngol Head Neck Surg. 2007;133(10):987-994. doi:10.1001/archotol.133.10.987 Photomicrographs of rat cochlea specimens. A and B, Low-power photomicrographs (scale bar indicates 200 μm) illustrating the cochlea with the scala tympani electrode array implant (A) and the contralateral control cochlea (B) of an immunized rat 86 hours following inner-ear inoculation of 1 × 10 3 colony forming units of Streptococcus pneumoniae (hematoxylin-eosin). This animal exhibited clinical and histologic central nervous system evidence of meningitis. In this example, there is a severe labyrinthitis apparent throughout the ear with the implant (A), while the contralateral cochlea (B) exhibits a less severe infection (arrow points to the bacteria and inflammatory cells in the scala tympani). *Artifact from histologic preparation. The c and d areas in panels A and B, respectively, are shown enlarged in panels C and D, respectively. C and D, Higher-power photomicrographs (scale bar indicates 10 μm) of gram-stained sections of the modiolus of the ipsilateral cochlea (C) and internal acoustic meatus of the contralateral cochlea (D) illustrate the presence of bacteria (arrows); bn indicates bone. Figure Legend: